tbuckley/cabot-search huggingface dataset:
Abstract 11421: Intervention With Cerebral Embolic Protection in Transcatheter Aortic Valve Implantation (INTERCEPTavi): Does Carbon-Dioxide Flushing Reduce Vascular Brain Injury?
Authors: Saud Khawaja, lydia hanna, Abhinav Singh, Stephen Crockett, Iqbal Malik, Sayan Sen, Neil Ruparelia, Nearchos Hadjiloizou, Mohamed Farag, Ramzi Y Khamis, Richard Gibbs, Ghada W Mikhail
Journal: Circulation (2022)

Background: Transcatheter Aortic Valve Implantation (TAVI) is associated with 2-3% clinical stroke rate and much higher incidence of silent cerebral infarction. This study investigated the neuroprotective benefits of minimising air emboli in TAVI. It aimed to demonstrate a reduction in vascular brain injury by flushing TAVI valves with CO 2 and saline compared to saline only as per standard practise. Methods: Patients undergoing transfemoral TAVI for aortic stenosis were enrolled. Patients were randomised to CO 2 and saline (TAVI-CO 2 ) versus saline only (TAVI-S) flushing of TAVI valves during preparation. Patients underwent MRI brain following TAVI to identify new cerebral infarcts and any reduction in vascular brain injury by reducing air emboli. Results: Twenty-Two patients were enrolled in the study with a mean age of 79±10 years. Fifteen (68%) were males. Nine patients (41%) had history of hypertension, 5 (23%) had previous cerebrovascular disease and 5 (23%) had diabetes. Two (9%) patients did not have their TAVI valve implanted and hence were excluded. No patients had any procedural related complications. Three (14%) patients required permanent pacemaker insertion post procedure and could not have their MRI. Fifteen patients (68%) had MRI brain post-TAVI, 7 patients in the TAVI-CO 2 group and 8 patients in the TAVI-S group. TAVI-CO 2 group had a total of 41 new cerebral lesions compared to 66 lesions in TAVI-S group. TAVI-CO 2 had on average 6.80 new lesions/patient compared to 8.25 lesions/patients in TAVI-S (p=0.34) Cerebral infarcts were also analysed according to valve type. In self-expanding valves (n=7), TAVI-CO 2 had 8 lesions/patient compared to 10 lesions/patient in TAVI-S (p=0.46). In balloon-expanding valves (n=8), TAVI-CO 2 had 4.25 lesions/patient compared to 6.25 lesions/patient in TAVI-S (p=0.25). Conclusion: There is a trend in the reduction in the number of new cerebral lesions in the TAVI-CO 2 arm compared to the TAVI-S patients. This is the first study that identifies the importance of air emboli in TAVI and the associated potential vascular brain injury. As brain injury remains a significant concern during TAVI, a larger randomised trial is required to further investigate the neuroprotective benefit of flushing TAVI valves with CO 2 .
Abstract 12216: Prevalence of Coronary Microvascular Dysfunction in Patients With Angina and Known Myocardial Bridge
Authors: Tess Allan, Michael Henry, Amit Patel, Husam H Balkhy, John Blair
Journal: Circulation (2022)

Introduction: Myocardial bridges are prevalent in patients with and without angina and can present a diagnostic dilemma when evaluating angina. Coronary microvascular dysfunction (CMD) is an important cause of chest pain in patients presenting with angina without obstructive CAD. The prevalence of concomitant CMD and myocardial bridge is not well described. Methods: All patients with known myocardial bridge and chest pain who underwent cardiac catheterization with bridge study at the University of Chicago Medical Center between 2020-2021 were included. All patients underwent pharmacologic testing with dobutamine with measurement of resting flow reserve (RFR). Abnormal RFR was defined as &lt; 0.8. Some patients additionally underwent coronary physiology study with adenosine (Ado) and/or acetylcholine (Ach) with determination of coronary flow reserve (CFR), index of microvascular resistance (IMR), and spasm (for Ach). Abnormal endothelial dependent microvascular function was defined as CFR &lt; 1.5 or IMR &gt; 31 on Ach testing. Abnormal endothelial independent microvascular function was defined as CFR &lt; 2.0 or IMR &gt; 25 on Ado testing. Results: A total of 27 patients (mean age 47 + 9, 60% female) were studied. There were 18 patients with hemodynamically significant bridge of whom 13 underwent surgical unroofing and 9 patients with hemodynamically insignificant bridge of whom 3 underwent surgical unroofing. There was no significant difference in rates of endothelial dependent or independent CMD or angiographic spasm between groups. Further coronary endotype data is displayed in Table 1. Conclusion: Endothelial dependent and independent microvascular dysfunction are prevalent in patients presenting with known myocardial bridge and chest pain and rates are not affected by hemodynamic significance of the bridge. Knowledge of coronary endotype in patients with myocardial bridge may assist in tailoring therapies to improve chest pain.
Abstract 12642: Protamine Administration in Patients Undergoing Percutaneous Left Atrial Appendage Occlusion
Authors: Jacob Alex, Chad Nicholson, Deborah Aina, Sukriti Banthiya, Shane Mckenna, Christian Machado
Journal: Circulation (2022)

Introduction: Intravenous protamine sulfate is widely used to reverse anticoagulation after structural heart interventions. Protamine is currently designated as in shortage by the US FDA, and its use has potential adverse events such as anaphylaxis, thrombosis, and stroke. There is limited data on the safety and efficacy of heparin reversal with protamine after left atrial appendage occlusion (LAAO). Hypothesis: We hypothesize that patients who received protamine for heparin reversal after percutaneous LAAO have no changes in bleeding complication rates versus patients who did not receive protamine. Methods: This retrospective study included 242 atrial fibrillation patients with a high risk of stroke and bleeding who received percutaneous LAAO between January 2020 and November 2021. The primary outcome assessed was life-threatening, disabling, or major bleeding within 48 hours following the procedure. Secondary outcomes included major adverse cardiac events (MACE) within 48 hours, minor bleeding events, MACE, device-related thrombosis or pericardial effusion within 45 days, and RBC transfusions. Patients with peri-procedure complications including pericardial effusion and/or thrombosis were excluded. Baseline characteristics were compared between both cohorts. Results: No significant difference in the primary outcome was observed between patients who received protamine compared to those who did not (5.8% vs 4.9%, p-value 0.57). There was significantly more minor bleeding in patients who did not receive protamine (0.6% vs 4.9%, p-value 0.05). MACE within 48h following the procedure, MACE, device-related thrombosis or pericardial effusion within 45 days, and RBC transfusions were comparable between the two cohorts, as described in table 2. Conclusions: Protamine administration for heparin reversal did not affect rates of life-threatening, disabling, or major bleeding complications in patients who underwent percutaneous LAAO.
Abstract 12159: Trends in Subsequent Myocardial Infarction Hospitalizations and Inpatient Mortality Among Cancer Patients With Prior Myocardial Infarction
Authors: Akhil Jain, Sandeep Singh, Hanieh Akbariromani, Mohammad Ali Mozaffari, Mohan Chandra Vinay Bharadwaj Gudiwada, Vinuthna Gaddam, Nazanin AHMADZADEH, Ayodya Perera, Hamna Naseem, Chetan Reddy Lankala, Hiren Chhayani, Rupak Desai
Journal: Circulation (2022)

Background: Patients hospitalized with subsequent/recurrent myocardial infarction (MI) suffer from high morbidity and mortality burden. Owing to the lack of contemporary data on cancer patients, we aimed to study the trends of subsequent Mi in this population. recurrent MI admissions and mortality in patients with prior history of MI and active cancer diagnoses. Methods: The National Inpatient Sample (2016-2019) was queried to identify adults with an active cancer diagnosis and prior MI hospitalization for subsequent MI admissions. Primary outcomes were nationwide trends in subsequent MI admissions and in-hospital mortality with sex and racial disparities. Trend analysis was performed by linear-by-linear regression method. Results: Cancer patients with prior MI (n=470755, median age 75 [IQ 67-82 years]) had 5.6% (26320) subsequent MI admissions. Subsequent MI hospitalizations mostly had male (69.3%), white (81.5%), enrolled in Medicare (81.1%), and South (31.1%) region admissions. Subsequent MI patients had higher complicated hypertension (58.4 vs 39.3%), diabetes with chronic complications (33 vs 21.4%), drug abuse (2.3 vs 1.4%) and obesity (13.6 vs 10.6%) than patients without subsequent MI. Subsequent MI admissions had a declining trend from 2016 to 2019 for both sex and all races except Hispanics (p trend &lt;0.05) [Fig. 1a]. All-cause in-hospital mortality showed a significant declining trend for males (p trend &lt;0.05), but a marginal increase was seen in females [Fig. 1b]. Furthermore, stratified by race, no significant change in mortality trend was noticed. Conclusion: There were declining trends in subsequent MI hospitalizations in cancer patients with prior MI in all sex/racial groups except in Hispanics. Males had improved outcomes in terms of in-hospital mortality, however, this improvement was not evident in females and on racial stratification.
Abstract 12722: The Impact of Covid-19 on Patients in Cardiac Rehabilitation Phase II
Authors: Kimberly Crutcher, Harrison Krebs, Yan A Su, Marilyn A Prasun
Journal: Circulation (2022)

Introduction: COVID-19 significantly affected outpatient cardiac rehabilitation which is a central resource for patients recovering from cardiovascular disease. The aim of the study was to examine the impact of COVID-19 on Cardiac Rehabilitation (CR) Phase II clinical outcomes. Methods: A single-site retrospective chart review of CR Phase II patients who completed 12 or more visits during 2019 (pre-COVID) and 2020 (COVID) was performed. Depression was measured using the PHQ-9, functional capacity was measured by the 6-minute walk in distance (ft) and metabolic equivalents (METs), and quality of life (QOL) was measured by the Ferrans and Powers Index. Descriptive and linear mixed methods were used to analyze the data. Results: A total of 212 patients who were predominately male 67% and 66.5 (SD=10.8) years old were included. PHQ-9 results showed a significant interaction COVID*pre-post scores F(1, 119.66) = 4.66, p = 0.03. For the remaining scores, all results showed significant improvements in pre-post: distance F(1, 151.90) = 226.92, p &lt;.001; METs F(1, 180.13) = 138.7, p &lt;.001; and QOL F(1, 145.32) = 5.89, p =0.02. Interactions were not significant for the three variables. QOL results showed significant differences in the COVID group with F(1, 239.12) = 6.13, p = 0.01. Conclusions: All four outcomes improved significantly in the pre-COVID and COVID sample. COVID significantly impacted depression PHQ-9 score change, with a pre-post improvement of 0.62 points in the pre-COVID group and 2.08 points during COVID. Finally, the mean overall QOL score was significantly lower in the COVID group than the pre-COVID group.
Abstract 11556: Sodium/Glucose Co-Transporter 2 Inhibition and Attenuation of the Action Potential Duration in Patient-Specific Re-Engineered Heart Cells With Congenital Long QT Syndrome
Authors: Wei Zhou, Maengjo Kim, David J Tester, John Giudicessi, Michael J Ackerman
Journal: Circulation (2022)

Background: Long QT syndrome (LQTS) stems from cardiac action potential duration (APD) prolonging pathogenic variants in KCNQ1 (LQT1), KCNH2 (LQT2), or SCN5A (LQT3). Sodium/glucose co-transporter 2 inhibitor (SGLT2i), a class of drugs used to treat type II diabetes and all forms of heart failure, reduces cardiac late sodium channel current. Objective: To test the ability of three commercially available SGLT2i to reduce APD in patient-specific induced pluripotent stem cell-derived cardiomyocyte (iPSC-CM) models of LQT1, LQT2, and LQT3. Method: Patient-specific iPSC-CMs and a CRISPR/Cas9 gene-edited variant corrected, isogenic control (IC) iPSC-CMs were generated. The variant-corrected IC was used to determine the curative APD in order to establish the degree of APD attenuation. The SCN5A-P1332L (LQT3) and IC iPSC-CMs were tested with 10 μM of either canagliflozin (CANA), dapagliflozin (DAPA), or empagliflozin (EMPA). An ATXII (5μM)-induced APD prolongation iPSC-CM model, mimicking drug-induced LQT3, was also treated. The APD was measured 30 minutes, 1 hour, and 2 hours after treatment using local extracellular action potential recordings on multielectrode array. The efficacy of these SGLT2i were also tested in KCNQ1-V254M (LQT1) and KCNH2-G604S (LQT2) iPSC-CMs. Results: The APD90 was prolonged in SCN5A-P1332L iPSC-CMs compared to its IC (469 ± 4 ms vs 305 ± 2 ms, p&lt;0.0001). While 10 μM of SGLT2i had no APD shortening effect on the KCNQ1-V254M or KCNH2-G604S iPSC-CMs, all three SGLT2i compounds shortened the APD90 of the SCN5A-P1332L iPSC-CMs after 1 hour of treatment from 463±5 ms to 432±6 ms (EMPA, 18.8% attenuation, p=0.0002), 459±8 ms to 430±5 ms (CANA, 17.5%, p=0.004), and 453±6 ms to 434±4 ms (DAPA, 11.4%, p=0.01). Additionally, IC iPSC-CMs treated with 5 μM of ATXII induced significant APD prolongation from 318±9 ms to 379±12 ms (p=0.0003) after 30 min incubation. However, co-incubation of ATXII and SGLT2i abolished the APD prolonging effect of ATXII. Conclusions: Therapeutically inhibiting SGLT2 effectively shortens the cardiomyocyte APD in human heart cell models of the LQT3, but not LQT1 or LQT2. This pre-clinical data compels further assessment of SGLT2i as a novel therapy for patients with congenital LQT3.
Abstract 12060: Ventricular Arterial Coupling - A Potential Biomarker in Children With Dilated Cardiomyopathy
Authors: Induja Gajendran, Daphne T Hsu, Ilir Agalliu, Joseph Mahgerefteh, Jacqueline M Lamour, Neha Bansal
Journal: Circulation (2022)

Introduction: Ventriculo-arterial coupling (VAC) ratio (normal value: 0.6 - 1.2) is worse in children with dilated cardiomyopathy compared to controls and is associated with poor heart failure (HF) outcomes. It has not been studied in patients on oral HF medications. Our aim was to study VAC ratio as a measure of response to therapy and its ability to predict worse outcomes in this population. Methods: A retrospective study of DCM patients &lt; 21 years on oral heart failure medications was conducted between 2010 and 2022 at the Children's Hospital At Montefiore. Medication data, NYHA functional class, and outcomes (mechanical circulatory support, transplantation, or death) were collected. A single observer analyzed the initial and the last echocardiograms on optimal HF therapy to calculate arterial elastance (EA), ventricular elastance (EES), and VAC ratio. Patients with and without outcomes were compared using chi-square &amp; Mann Whitney tests, as appropriate. Results: Thirty-one patients (median age at diagnosis 1.25 (IQR 7.7) years) were followed for a median of 4.92 (IQR 11) years. There was a significant improvement in the VAC ratio (mean 1.85 vs 1.46, SEM 0.17, P=0.02) from diagnosis to the last follow-up with a median change of -13.5%. There was a statistically significant association between the percent change in VAC and change in the NYHA class (P=0.0001). Outcome events occurred in 7 patients; one required mechanical circulatory support, two died, and four underwent transplants. Patients with an outcome event had a worse VAC ratio both at diagnosis (P=0.03) and at the last follow-up (P=0.0001) and a worse NYHA class (P=0.001) at the last follow-up (Table). Conclusion: VAC is a potential biomarker for response to therapy and is associated with poor outcomes in pediatric DCM. It provides mechanistic insights into HF in this population.
Abstract 12087: Improving Characterization of Abdominal Aortic Aneurysms by Modeling Thrombosis
Authors: Seyedmostafa Rezaeitaleshmahalleh, Zonghan Lyu, Kristin King, Jan M Hofer, David Liedl, Xiaoming Zhang, Todd Rasmussen, Robert D McBane, Jingfeng Jiang
Journal: Circulation (2022)

Introduction: In seniors, the prevalence of abdominal aortic aneurysms (AAA) is high (9-10%). We aim to characterize AAA growth rates (slow vs. rapid) to help inform management strategies, including individualized imaging surveillance frequency. Hypothesis: Modeling thrombosis may improve the characterization of AAAs' growth status. Methods: 3D geometrical AAA models with and without thrombosis (vessel lumen only) were generated for 70 human subjects using available contrast-enhanced CTA data. AAA growth rates were categorized as slow (&lt; 5 mm/year) or rapid (≥ 5 mm/year) based on serial imaging. Python scripts were used to calculate geometrical parameters (83) with and without thrombosis. Patient-specific relevant health information was retrieved through a review of medical records. Support vector machine (SVM), a well-established machine learning method, was run with 10-fold cross-validation (100 iterations) to assess the predictive accuracy. Results: Among 70 AAAs studied, the ratio between rapidly-growing and slowly-growing was nearly 1:2. The combination of antihypertensive medication, coronary artery disease, juxta-aneurysm aortic size, and five geometrical parameters quantifying the extent of thrombosis provided the best accuracy for AAA's growth status. The area under receiving operating curve (AUROC) was 0.85, and total accuracy was 0.81, with 57% and 93% of rapidly- and slowly-growing AAAs correctly identified, respectively. Excluding patients with aneurysm thrombus, the AUROC and accuracy in predicting rapidly-growing AAAs decreased to 0.82 and 48%, respectively. Conclusions: machine-learning-based predictive modeling appears feasible for characterizing AAA's growth rate status. Manual aortic image segmentation, required for data analytics, is labor-intensive (on average, 1 hour). Leveraging artificial intelligence-based segmentation methodology may provide an automated solution to improve workflow and feasibility.
Abstract 11177: Pulmonary Vein Reconnections Predict Good Clinical Outcomes After a Second Catheter Ablation of Persistent Atrial Fibrillation: Insight From the EARNEST-PVI Trial
Authors: Masato Okada, Nobuaki Tanaka, Takafumi Oka, Koji Tanaka, Yuko Hirao, ATSUNORI OKAMURA, Katsuomi Iwakura, masaharu masuda, Tetsuya Watanabe, Akihiro Sunaga, Shungo Hikoso, Koichi Inoue, Yasushi Sakata
Journal: Circulation (2022)

Introduction: The effect of an extensive ablation strategy in addition to pulmonary vein (PV) isolation is still controversial in persistent atrial fibrillation (AF) ablation. Electrical PV reconnection is an important confounder affecting the trial results. Objectives: To evaluate the PV reconnection rate and association between the reconnection and AF recurrence after a re-do AF ablation in the EARNEST-PVI trial (NCT03514693). Methods: The analysis was performed using the extended data of the EARNEST-PVI trial (N=512), a randomized controlled trial to evaluate ablation strategies for persistent AF, which was conducted in the Osaka region of Japan. During a median follow-up of 47 months, a total of 126 (25%) patients underwent a re-do AF ablation. Among them, 120 (median age, 68 years; 36% female; 31% long-standing persistent AF, 95% contact force-sensing catheter use) whose follow-up data were available after the 2 nd AF ablation were enrolled in this study. Results: PV reconnections were observed in 75 (63%) patients. Although there was no difference in age, gender, long-standing persistent AF, and CA strategy during the index procedure, AF recurrence within 1 year was more frequent in patients with PV reconnections (81.3% vs. 64.4%, p = 0.039). During a median follow-up of 31 months after the re-do AF ablation, patients with PV reconnections had a lower clinical recurrence rate than those without (38.7 vs. 44.4%, log-rank p = 0.047). However, additional linear ablation did not affect the recurrence rate. Even after adjustment for age, gender, long-standing persistent AF, and presence of non-PV triggers, Cox regression analysis revealed that a number of reconnected PVs of ≥2 was independently associated with a lower recurrence of AF after the 2 nd AF ablation (hazard ratio, 0.36; 95% confidence interval, 0.19-0.67; p = 0.001). Conclusions: Among patients who underwent a redo-AF ablation in the EARNEST-PVI trial, about two-thirds exhibited PV reconnections. Patients with ≥2 PV reconnections had better clinical outcomes than those with ≤1 PV reconnections. A durable PV isolation is an important pre-requisite before exploring any additional ablation strategies for persistent AF.
Abstract 11574: Relationship Between Baseline Electrocardiographic Parameters and Outcomes in Patients With High-Risk Heart Failure With Reduced Ejection Fraction: Insights From the Vericiguat Global Study in Patients With Heart Failure With Reduced Ejection Fraction (VICTORIA) Trial
Authors: Haran Yogasundaram, Yinggan Zheng, Eric Ly, Justin A Ezekowitz, Christopher M OConnor, Robert O Blaustein, Lothar ROESSIG, Tracy C Temple, Cynthia M Westerhout, Paul W Armstrong, Roopinder Sandhu
Journal: Circulation (2022)

Background: Patients with chronic heart failure with reduced ejection fraction (HFrEF) and recent decompensation are at high risk of cardiovascular (CV) events including mortality; risk stratification remains challenging. To further assess risk in this population, we characterized their baseline 12-lead ECGs and their prognostic value in 4880 patients (24% female) from the VICTORIA study. Methods: Baseline ECG parameters were interpreted in a core laboratory blinded to centrally adjudicated clinical outcomes. There were 1799 primary composite events (time to first HF hospitalization (HFH) or CV death) and 1005 total all-cause deaths (21% sudden). The MAGGIC-adjusted association between baseline ECG parameters and outcomes are presented as hazard ratio (HR) and 95% confidence intervals (CIs). Results: Incidence rates of baseline ECG parameters and their association with all-cause death and the primary composite outcome are shown below. The median MAGGIC score was 24 (19, 28) points. Higher heart rate, greater QRS duration, and prolonged QTc were significantly associated with the primary composite and all-cause death ( Table ), as well as for CV death ([HR 1.04, 95% CI 1.02-1.07; p&lt;0.001] [HR 1.02, 1.00-1.04; p=0.015] [HR 1.16, 1.00-1.34; p=0.049]), respectively. Sex-based interactions were evident for contiguous Q waves on all-cause death (male: HR 0.98, 0.82-1.17; female: HR 1.56, 1.15-2.12; interaction p=0.010) and CV death (male: HR 1.03, 0.85-1.25; female: HR 1.66, 1.17-2.34; interaction p=0.019). Additionally, contiguous Q-waves were associated with sudden death (HR 1.45, 1.05-2.00; p=0.022) and appeared to double the risk in females (male: HR 1.25, 0.87-1.79; female: HR 2.50, 1.23-5.06; interaction p= 0.087). Conclusion: Routine ECG parameters are associated with worse outcomes in high risk HFrEF patients—particularly in females with contiguous Q waves.